BILL ANALYSIS Ó SB 319 Page 1 Date of Hearing: August 19, 2015 ASSEMBLY COMMITTEE ON APPROPRIATIONS Jimmy Gomez, Chair SB 319 (Beall) - As Amended July 7, 2015 ----------------------------------------------------------------- |Policy |Human Services |Vote:|7 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | |Health | |19 - 0 | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- Urgency: No State Mandated Local Program: YesReimbursable: No SUMMARY: This bill expands the duties of the foster care public health nurses to include monitoring and oversight of the administration of psychotropic medication to foster children, as specified. Specifically, this bill: SB 319 Page 2 1)Authorizes a provider of health care to disclose medical information to a foster care public health nurse to coordinate health care services and medical treatment for a minor who has either been taken into temporary custody, had a petition filed with the court, or been adjudged a dependent child or ward of the juvenile court, as specified. 2)Requires the foster care public health nurse and the child's social worker to consult, collaborate, and share information in a timely manner to ensure that the child's physical, mental, dental, and developmental needs are met. 3)Requires that a foster care public health nurse have access to a child's medical, dental, and mental health care information in order to allow that nurse to fulfill his or her duties. 4)Requires a foster care public health nurse, at the request of a nonminor dependent, to assist him or her in making informed decisions about his or her health care by, at a minimum, providing educational materials. 5)Adds to the duties of a foster care public health nurse the monitoring of each child in foster care who is administered one or more psychotropic medications, as specified. FISCAL EFFECT: 1)Ongoing costs of approximately $12 million ($3 million GF) to DCHS for public health nurses to collaborate with social workers and to monitor, review and document information related to the administration of psychotropic medications, SB 319 Page 3 assuming an average caseload of 1:200. 2)Ongoing non-reimbursable costs of approximately $6 million ($4.85 million GF) for county social workers to consult, collaborate and share information with foster care public health nurses. (Proposition 30 exempts the State from mandate reimbursement for realigned programs, however, legislation that has an overall effect of increasing the costs already borne by a local agency for realigned programs, including child welfare services, apply to local agencies only to the extent that the State provides annual funding for the cost increase.) 3)Onetime costs of $45,000 ($22,000 GF) and ongoing costs of $7,000 ($3,500 GF) to DHCS to develop curriculum and train public health nurses. COMMENTS: 1)Purpose. This is one of four bills proposing a set of reforms aimed at curbing excessive and inappropriate authorization and administration of psychotropic medications among foster youth. The author states that nearly one in four foster children and 56 percent of children in group homes are receiving psychotropic drugs, often without adequate oversight. The author further states that without adequate oversight, these medications can cause irreversible damage, and many youth experience long-term side effects, including diabetes, heart disease, irreversible tremors, tics, weight gain and drowsiness. This bill utilizes public health nurses to oversee the medical monitoring of psychotropic drugs to increase oversight and reduce the number of children prescribed these drugs. 2)Background. AB 1111 (Chesbro), Chapter 147, Statutes of 1999, SB 319 Page 4 required DSS to establish a program of public health nursing within the child welfare services program. This program - the Health Care Program for Children in Foster Care- is located in county child welfare agencies and probation departments, and serves to assist in meeting the medical, dental, mental health, and developmental needs of foster youth. Foster care public health nurses work with child welfare caseworkers and probation officers to promote access to comprehensive health services. Federal funding requirements stipulate that the services provided by foster care public health nurses must be limited to health-related case management and not involve the provision of direct health care services. Under the supervision of supervising public health nurses, foster care public health nurses consult and collaborate with social workers and probation officers to provide services such as: medical and health care case planning; expediting referrals for medical, dental, mental health and developmental services; and helping to develop and maintain each child's Health and Education Passport, which provides a summary of all obtainable health and education information for foster youth that travels with each youth throughout out-of-home placement. According to the County Welfare Directors Association of California, there are approximately 250 foster care public health nurses working throughout the state. Research has repeatedly indicated that children and youth in foster care face higher levels of inappropriate or excessive medication use, and that those foster youth placed in group home settings are particularly vulnerable to over-prescription and misuse of psychotropic medications. Data provided by the Department of Health Care Services (DHCS) indicate that, in fiscal year 2013-14, almost 15% of all foster youth in California ages 0 to 20 years old were prescribed at least one psychotropic medication; for foster youth ages 12 through 20, SB 319 Page 5 this rate was almost 25% and for youth placed in group homes, it was 50%. 3)Related Legislation. The following bills are part of a four-bill package (including this bill) regarding the use of psychotropic medication for children in foster care. All are before this Committee today. a) SB 238 (Mitchell), 2015, requires DSS to develop expanded training for foster parents, social workers, group home administrators, and others involved in the care and oversight of dependent children on issues related to psychotropic medications. b) SB 253 (Monning), 2015, modifies juvenile court practices and requirements regarding the authorization of psychotropic medications for foster youth by, among other things, requiring clear and convincing evidence that administration of the medication is in the best interest of the child and, in specified circumstances, prohibiting the authorization of psychotropic medication administration for a child unless a second opinion is obtained from a child psychiatrist or behavioral pediatrician. c) SB 484 (Beall), 2015, requires DSS to compile and post on its Internet Web site specified information regarding the administration of psychotropic medications to children placed in group homes and to establish a methodology for identifying group homes with high levels of psychotropic drug use. Further establishes certain requirements for those group homes. SB 319 Page 6 Analysis Prepared by:Jennifer Swenson / APPR. / (916) 319-2081